Thank you for the replies, people.
I am extremely low functioning at the moment. I shower maybe once every 2 weeks, and that is a hard thing to admit because yes, it's gross. But I don't care. And when I do shower, it does not have an affect on making me feel accomplished.
That is my point, whether or not people think I should do small goals, they do not provide a reward for me. This is probably a chemical issue, I would guess, having a total lack of dopamine. My brain's reward system is broken, and I am not sure how one goes about fixing it other than medication (which I do take). So while I have tried small goals for an extended period, I feel no different months later on that path of therapy.
With what I have described, one would think my house is like an episode of hoarders. But it's not, I do have a line drawn where I find a level of grossness unacceptable, and I will take steps to fix it, but what I am trying to do is raise that line higher and it won't budge.
Most of the advice here has been what I've already tried, and has not worked. So now I'm wondering what a person does with their life when their brain's reward system is broken, and cannot be trained to function properly even with medication.